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Editorial: Improving life for thousands of needy residents

With the stroke of a pen last week, New Hampshire Gov. Maggie Hassan signed into law an enormous expansion of health insurance coverage, accomplishing one of her major priorities and bringing a life-changing benefit to 50,000 needy residents across the state.

It’s about time.

The New Hampshire Legislature – the Democratic House and the Republican Senate – had been sparring over Medicaid expansion for months. Part of the federal Affordable Care Act, the initiative was intended by President Obama to cover poor adults in all 50 states, and in the early years, the expansion will be covered entirely by federal dollars. Without it, Obamacare ends up helping all but the poorest members of the community, an upside-down result, to say the least. But the U.S. Supreme Court ruled that states had the right to opt out, which led to 50 state-level debates including, slowly, New Hampshire’s.

The New Hampshire plan will inject hundreds of millions of dollars in federal money into the state economy. And while it’s still being called “Medicaid expansion,” the measure will ultimately use federal Medicaid money to buy private health coverage for residents making less than 138 percent of the federal poverty limit, about $15,856 a year for a single adult.

New Hampshire is not the first state to try to put its own stamp on the program, and it will be in policy-makers’ interest to pay close attention to the results of the decision here – and elsewhere – to use the money for private insurance rather than traditional government coverage.

There are, clearly, pros and cons to the approach.

With private insurance, newly eligible Medicaid enrollees will be able to keep their coverage even if their earnings increase and they eventually make too much to qualify for Medicaid. That continuity of coverage could create real peace of mind for patients who might otherwise be shuffled back and forth between Medicaid and private insurance.

But some states heading in a similar, private-insurance direction have tried to get federal permission to ignore some of the traditional Medicaid requirements. Iowa, for instance, got approval to opt out of paying for non-emergency transportation to medical appointments, a standard Medicaid benefit. The feds intend to evaluate the Iowa exemption after a year to see whether it has hurt beneficiaries’ access to care. It’s hard to see how it wouldn’t, but a positive evaluation from Washington might well encourage other states to engage in similar scrimping.

Additionally, the jury is still out on whether allowing states to expand coverage through private insurers will end up costing the government more than traditional Medicaid, which typically pays doctors and hospitals less than private insurers. If the cost is more, there could be real pressure on states to reduce the number of people covered or benefits provided.

Indeed, like much of the Affordable Care Act, Medicaid expansion remains a work in progress – not surprising, given the enormity of the venture. There may well be room for improvement along the way. But for tens of thousands of poor residents in New Hampshire, life just got significantly better. For that, they have their governor and Legislature to thank.

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